02 October 2008

Increased cases of rare pneumonia strain among deployed troops

LANDSTUHL, Germany — Military doctors are seeing a resurgence of a rare and sometimes fatal type of pneumonia that is striking young troops who started smoking while deployed downrange.

In the past five months, six U.S. servicemembers serving in Central Command’s area of responsibility have been diagnosed with acute eosinophilic pneumonia, or AEP. While the exact cause of the illness is unknown, 27 of the 36 troops who have contracted AEP since March 2003 had recently picked up the habit, according to a July 2008 information paper from the Army’s Center for Health Promotion and Preventive Medicine.

Also, three-fourths of those troops came down with the illness while serving in Iraq. Other cases have originated with U.S. troops in Afghanistan, Djibouti, Kuwait, Qatar and Uzbekistan.

Two troops have died as a result of the disease.

On average, the AEP patients are around 22 years old, said Air Force Maj. (Dr.) Patrick Allan, a critical care pulmonary physician at Landstuhl Regional Medical Center.

AEP is noninfectious and strikes within 2 weeks of starting smoking. It also strikes quickly:

In one to four days, patients may notice shortness of breath, a dry cough, chest pain and non-specific abdominal pain. Within 24 hours after going to a clinic, patients typically require supplemental oxygen or have to be put on a breathing machine, Allan said....In addition to the two servicemembers who died from complications of AEP, there have been others who were near death before recovering, doctors said. Landstuhl sent its specialty lung team downrange to treat three troops with AEP. The patients were so bad doctors had them on highly technical breathing machines to keep them alive.

A medical alert about AEP was issued in Iraq as early as February 2007. But because it is so rare there was not enough evidence to suggest a link with deployments.

Now, young patients arriving at Landstuhl’s intensive care unit with pneumonia-like symptoms will immediately have their lungs examined for AEP, Allan said. Whereas "standard" pneumonia is usually treated with powerful antibiotics, AEP is treated with steroids that suppress the body’s immune system.

The treatment is highly successful, once AEP is diagnosed. But doctors still have no explanation for the disease's current resurgence.